Today, Joe Lifsted can walk up to two miles on a treadmill without experiencing the telltale signs of fatigue that once encumbered him.
Just a few short weeks ago, the Ryerson Road resident said, “I didn’t do much exercise. And I had a few situations where I did try to walk a long distance, and I had angina. Now I can walk a long distance without any ill effects.”
Lifsted credits a relatively new treatment called Enhanced External Counterpulsation (EECP) as the source of his physical turnaround.
For the last six weeks, Lifsted has been a patient of Dr. Debra Braverman’s VitalHeart clinic at 700 Cottman Ave., which administers the therapy. In addition to the Northeast location, Braverman, a former University of Pennsylvania Hospital physician and academic, operates clinics in Center City, Haverford and Cherry Hill, N.J.
Like hundreds of other VitalHeart patients, Lifsted, for an hour each day, five days a week, gets strapped to an EECP table.
Some patients listen to music through headphones. Others read while receiving the jostling tabletop treatment that emits a chugging sound reminiscent of a hardware-store paint mixer.
This odd-sounding device facilitates increased blood flow to the heart through an external pumping action.

A PRESSURE SITUATION
The EECP table, which has been approved by the U.S. Food and Drug Administration, employs a series of air-pressurized cuffs attached to a patient’s calves, thighs and buttocks. The cuffs inflate and deflate in time with the heartbeat.
The result is a stimulation of “microscopic blood vessels in the heart muscle” that can relieve the workload of the three main coronary arteries that provide oxygenated blood to the heart, explained Braverman.
EECP can function as an alternative to traditional invasive procedures – such as bypass, angioplasty or stents – that relieve chronic heart disease and blocked arteries, or as a maintenance plan for patients who previously have gone under the knife.
“The typical profile is someone who has been living with heart disease for ten years or longer,” Braverman said of EECP patients, “and has already had some type of invasive procedure. And at this particular time that patient either cannot have another surgery (because of physical frailty) or doesn’t want to.
“There’s a growing number of people who are learning about this therapy who are saying, ‘Before I have surgery, before I have angioplasty, before I do any of these invasive procedures, let me explore this non-invasive therapy first,’” she continued.
“That groundswell is really growing among the patient population as the word about this therapy and how it works is becoming more understood. So that type of patient, someone using the sooner-rather-than-later philosophy, is becoming more frequent, but by far that’s the minority.”

INSURERS ARE ON BOARD
The Food and Drug Administration approved EECP in 1995, according to agency spokeswoman Sharon Snyder. In 1999, Medicare and other health insurance companies began to cover the treatment, which costs considerably less –treatments typically range from $5,000 to $9,000 – than the majority of invasive surgical procedures.
Though EECP is a newer medical innovation, the technology that is the foundation of the treatment has been around for decades. In the early 1950s, Harvard researchers first experimented with counterpulsation as a technique to assist patients with coronary inadequacies.
A decade later, that research was used to develop an internal counterpulsation device known as the intra-aortic balloon pump. That apparatus inserted a catheter with a small balloon attached at the tip into the ascending aorta, the body’s main blood vessel, via the femoral artery to support circulation of a critical cardiac patient.
Today, EECP is the most modern version of counterpulsation therapy.
Most EECP patients undergo a standard 35-hour course of treatment during a seven-week period.
With the use of Velcro, patients are positioned on one of five EECP tables at the Cottman Avenue VitalHeart office, followed by attachment of the flexible nylon cuffs, which function in much the same way that blood-pressure sleeves do.
Each cuff is attached to the bed by a hose. The hoses in turn are connected to an air compressor.
The patient also is connected to an electrocardiogram (EKG), which monitors heart rate. The air compressor is synchronized with the EKG so that the cuffs inflate and deflate, causing a squeezing motion, as the heart beats.
“The way this apparatus operates is when your heart muscle is at rest and the blood is naturally returning to the heart, that’s exactly when the cuffs squeeze, just enhancing and promoting that natural return,” Braverman said.
“Just before the heart contracts again, the cuffs open simultaneously and in that way make it easier for the heart to send the blood back out to the rest of the body. So it’s working as an external circulatory assistant.”
The aim, she said, is to keep the blood moving.
“It’s a passive form of exercise where we’re exercising the circulatory system by getting that blood to flow around and around. That’s the key to making your blood vessels as healthy as possible,” she explained. “The more and more the blood flows through the vessels, the healthier they are, the more normalized they function and the more blood they are able to bring to the designated tissues.”
As successful as EECP has been – a handful of medical studies has concluded that three-quarters of patients who received the treatment reported that its benefits persist – there are some physicians who question the process and its effectiveness.
Braverman attributes that skepticism to the conservative nature of physicians.
“This is a different type of treatment, and it’s outside of the usual algorithm. I think that, in academic medicine, the cardiology community is very open and excited and accepting, and actually leading the way with this therapy,” Braverman said. “All of the clinical research has been done by leading cardiology departments and cardiologists in academic centers around the country. So they’re really leading the way. And the regular, community-based cardiologist in private practice is slowly but surely coming around.”
Skeptics notwithstanding, EECP has been endorsed by the American Heart Association and the American College of Cardiology.
But whatever method patients opt for to treat their heart ailments, Braverman notes, the heart still won’t be quite what it used to be.
“There’s no cure for heart disease,” she said. “It’s a manageable disease, and there are multiple ways to manage it, whether it’s medications, surgery or EECP.” ••

For more information, visit the Web site at www.vitalheart.net